NPI | 1609200385 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA 30042) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301015413) |
Enumeration Date | 2013-08-29 |
Last Update Date | 2018-05-08 |